So now we're going to move on to a
comprehensive examination of the eye.
Elsewhere in this course, we'll
be looking at the cranial nerves,
which will help us to look for visual field
cuts and function of the ocular motor muscles.
So this is more looking at the external eye
and then doing the fundoscopic exam as well.
So the eye is an incredibly useful place to look
for evidence of various types of systemic disease.
Starting off, a simple thing is just to
look for evidence of hyper- and hypovolemia.
Patients who have periorbital
edema with inflammation of the or,
I should say, edematous eyelids and some
increased puffiness around the eyes,
that may be an indication of nephrotic syndrome or
potentially in the setting of heart failure as well.
And in fact, folks who have sunken eyes, that sort of
appearance of the eyeball being sunk back in the socket
has a significant likelihood ratio
for helping to identify hypovolemia.
Likewise, we can look for evidence of
anemia simply by looking at the eye.
So if I just pull down her
lower eyelid, may I, Shayla?
Just pulling down the lower lid, you can see
on an eyelid there is a rim which is anterior,
which is somewhat erythematous, and then
posteriorly, closer to the eye is a more pale area.
Now folks who have anemia with
the hemoglobin of less than 11
will have so-called conjunctiva rim pallor where
the proximal anterior portion of that eyelid
is just as pale as the
posterior portion of the eyelid.
And that is a really strong diagnostic test.
In addition, elsewhere, we'll be
talking more about thyroid disease
and you can have significant evidence of
hyperthyroidism, both increase sympathetic tone
as well as evidence of Grave's disease,
with the eyeballs being pushed out by
edematous ocular motor musculature.
And then looking for diseases that are
more specific to the eyes themselves.
Patients can have edema of one particular
eyelid, either the top one or the bottom one
in the setting of not just systemic disease, but
also something as simple as a stye or hordeolum.
Just lifting up the eyelids, you can look to see
if there's any evidence of any stye in the eye.
Sometimes patients will have blpeharitis, which
is inflammation and edema and sometimes some scale
at the margins of the eyelids there as well.
And then, of course, conjunctivitis.
Patients with either viral or bacterial
conjunctivitis will have red sclera,
and it's always good to remember that viral
conjunctivitis is an ophthalmologic manifestation
of a systemic infection.
So patients oftentimes will have
conjunctivitis in one eye on the left
and then a day or two later it will show up on the
right and they presume that they have spread it.
But in fact, it's just that the ophthalmological
manifestation of this systemic disease
happens to be presenting asymmetrically.
It's not actually being spread
from one eye to the next.
In contrast, bacterial conjunctivitis will
be a much stronger redness in the eye.
And most notably, when you pull down
on the eyelids, if you clear away the,
any mucopurulent material during the exam, you
may find that with bacterial conjunctivitis
within minutes, so more mucopurulent
discharge will actually show up.
And that really tells you you're dealing
with a bacterial process rather than a viral
where people tend to wake up with
some crusty eyes in the morning.
But other than a little bit of a gritty sensation
throughout the day, they're not having this
constant development of
mucopurulent material in the eye.
In addition, you can look for jaundice in the eye.
Patients who have a bilirubin level of
at least 3 or 4 milligrams per deciliter,
you'll start to see some
yellowing in the conjunctiva.
Some patients develop pterygium, which
is where there's this increased growth of
of hyper proliferation of conjunctiva that comes
in from either the lateral side or the medial side
and can actually encroach over
into the the area of the iris.
So-called pterygium, which comes from the
same root of the word as 'Pterodactyl'.
Ptery- meaning 'wing' and it's basically a wing of
conjunctiva tissue that's now encroaching across
the anterior surface of the iris.
It's a benign condition in general.
And next up, looking at diseases
specifically of the eyeball itself,
or I should say of the anterior chamber of the eye.
If a patient has iritis, which is
essentially a type of anterior uveitis,
you may see what's called a cilliary flush,
where there's redness just around in a rim,
sort of a halo around the iris.
And that would be present in some
autoimmune conditions, you may see that.
versus episcleritis and scleritis,
which is going to involve the sclera
rather than the anterior chamber.